Provider Demographics
NPI:1093144396
Name:STILT, DEBORAH (MA ED)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:STILT
Suffix:
Gender:F
Credentials:MA ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 578
Mailing Address - Street 2:
Mailing Address - City:SKYFOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92385
Mailing Address - Country:US
Mailing Address - Phone:909-336-1800
Mailing Address - Fax:909-336-0990
Practice Address - Street 1:28545 STATE HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:SKYFOREST
Practice Address - State:CA
Practice Address - Zip Code:92385
Practice Address - Country:US
Practice Address - Phone:909-336-1800
Practice Address - Fax:909-336-0990
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-S1307220732101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor